Beware of Omniscient Doctors
by Jonathan Rosenblum
July 16, 2008
We described last week the sweeping claim made by the Winnipeg doctors attending the late Samuel Golubchuk that their superior medical knowledge confers upon them absolute authority to determine when life has ceased to be of sufficient quality to be worth sustaining by artificial means. That claim constitutes a glaring example of what philosopher Dr. Leon Kass terms "soulless scientism," the belief that scientific knowledge translates into philosophical or moral insight.
But, as Kass notes in the Spring issue of Azure, science and moral thought operate on two unconnected planes: "Science seeks to know only how things work, not what things are and why. Science gives the histories of things, but not their aspirations or purposes." Science is "notoriously morally neutral."
That is a distinction increasingly lost on many scientists. As their knowledge of how things work has expanded, they have made the untenable leap to the conclusion that everything, including human thought, can be reduced to predetermined material processes. Harvard psychologist Stephen Pinsker, for instance, seeks to establish by virtue of the fact that the brain can be dissected with a knife, altered by chemicals, extinguished by a sharp blow that there is no such thing as a soul endowed by G-d.
To which Kass replies: "He does not understand that the vital powers of an organism do not reside in its constituent materials as such, but emerge only when those materials are formed and organized in a particular way; he does not understand that the empowering organization of materials â" the vital form or soul â" is not itself material." Objective science, no less than human freedom and dignity, Kass argues, cannot exist in deterministic, material universe: "[T]he very possibility of science depends on the immateriality of thought and on the mind's independence from the bombardment of matter."
WE HAVE BEEN DOWN THE PATH of doctors claiming moral omniscience before. Then too they based their claims on contemporary scientific doctrines. Then, as now, they spoke of the quality, as opposed to the sanctity of life. Professor Richard Weikart, author of From Darwin to Hitler: Evolutionary Ethics, Eugenics, and Racism in Germany, estimates that a majority of German physicians and scientists, in the half century leading up to Hitler's rise to power, subscribed to the naturalistic Darwinian world view and ito deas that constituted a sustained assault on the traditional Judeo-Christian concept of the sanctity of life.
Among those ideas are the claim that there is no fundamental distinction exists between humans and animals; human beings do not possess a soul that endows them with any rights or superiority to any other species; within the species homo sapien, there are "inferior" and "superior" individuals, and inferior and superior races; and it is the iron will of nature that the species should evolve through the survival of the superior members and the death of the inferior.
Ernest Haeckel, one of the most influential 19th-century German biologists, whose faked drawings of developing human embryos, allegedly recapitulating the evolutionary path, still feature prominently in college biology texts, argued for the killing of the mentally ill, lepers, those with incurable cancer, and cretins. As a safeguard, he recommended a committee of physicians to pass judgment.
Alfred Hoche, a professor of psychiatry at the University of Freiburg, justified shortening an inferior life if the insights gained would save better lives. "By giving up the conception of the divine image of humans under the influence of Darwinian thinkers," writes Hans-Walter Schmuhl, mainstream German thinkers came to view human life as "a piece of property" to be weighed against other pieces of property.
THE SLIPPERY SLOPE from easy talk about the "quality of life" is readily observed, even without recourse to examples from pre-Nazi German medicine. That is why the American Association of People with Disabilities has been so actively involved in a string of cases dealing with doctors' right to terminated medical care. They fear becoming the next victims of doctors claiming the moral ability to weigh the value of a human life.
Dr. Daniel Eisenberg, an expert in Jewish medical ethics, offers one recent chilling example of physicians' haste to terminate life. On June 17 2006, the Supreme Judicial Court of Massachusetts granted the request of the Massachusetts Department of Social Services to cut off the respirator from Haleigh Poutre, an 11-year-old girl, who had been savagely beaten by her aunt and step-father. The court was informed that Haleigh was "in an irreversible and permanent coma, with the least amount of brain function that a person can still have and be considered alive."
As it happens, little Haleigh had already begun to show signs of responsiveness a week before the Massachusetts court entered its judgment. (The day before judgment was entered she began to breathe independently.). Nevertheless, the doctors insisted that her chances of recovery were absolutely zero and told the Department of Social Services that there was no need to inform the court of her improvement.
That case, writes Eisenberg, is a good example of the slide into the abyss of allowing ethical decisions to be outsourced to doctors "who all too often do not view life as intrinsically valuable." Remarkably in the Poutre case, the doctors determined that she was in a permanent vegetative state after only eight days, even though the definition of a permanent vegetative state is at least one month. More than half of brain-injured patients recover consciousness after a month in coma, and 16% after three months. For children, whose brains are faster-growing and more elastic, the prognosis is significantly better.
The pleadings in the Golubchuk case also contain another example from nearby Calgary of doctors' unseemly haste to dispatch a patient they deemed not worth preserving. The family of a Mr. Jin went to court after doctors entered a Do Not Resuscitate order in his file. The doctors claimed he would either die or remain in a persistent vegetative state as a consequence of a fall. The family prevailed, and Mr. Jin recovered well enough to speak, write, and read. Meanwhile the doctors appealed the court's grant of an injunction restricting their autonomy to determine the level of medical care to be given a particular patient.
The Manitoba College of Physicians and Surgeons of Manitoba (the Canadian province in which Samuel Golubchuk lived and died) recently convened a medical ethics conference to discuss its statement on withholding and withdrawing life-sustaining treatment. That statement confers complete autonomy on the treating physician to make those decisions regardless of the wishes of patients or their family members.
Dr. Jocelyn Downie, professor of law and ethics at Dalhousie University, went right to the nub of the issue: "You are deciding as physicians what lives are worth living, and that's a moral judgment not a medical judgment. It goes too far, and that's dangerous."
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